Fillable PCI Self-Assessment Questionnaire B Attestation of Compliance 2017

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Payment Card Industry (PCI)

Data Security Standard

Self-Assessment Questionnaire B

and Attestation of Compliance

Merchants with Only Imprint Machines or

Only Standalone, Dial-out Terminals – No

Electronic Cardholder Data Storage

For use with PCI DSS Version 3.2

Revision 1.1

January 2017

PCI DSS v3.2 SAQ B, Rev. 1.1 January 2017

Document Changes

Date

PCI DSS

Version

SAQ

Revision

Description

October 2008

1.2

To align content with new PCI DSS v1.2 and to implement

minor changes noted since original v1.1.

October 2010

2.0

To align content with new PCI DSS v2.0 requirements and

testing procedures.

February 2014

3.0

To align content with PCI DSS v3.0 requirements and

testing procedures and incorporate additional response

options.

April 2015

3.1

Updated to align with PCI DSS v3.1. For details of PCI

DSS changes, see PCI DSS – Summary of Changes from

PCI DSS Version 3.0 to 3.1.

July 2015

3.1

1.1

Updated to remove references to “best practices” prior to

June 30, 2015.

April 2016

3.2

1.0

Updated to align with PCI DSS v3.2. For details of PCI

DSS changes, see PCI DSS – Summary of Changes from

PCI DSS Version 3.1 to 3.2.

January 2017

3.2

1.1

Updated version numbering to align with other SAQs

PCI DSS v3.2 SAQ B, Rev. 1.1 January 2017

Table of Contents

Document Changes .................................................................................................................. i

Before You Begin .....................................................................................................................iii

PCI DSS Self-Assessment Completion Steps ...................................................................................... iii

Understanding the Self-Assessment Questionnaire ........................................................................... iv

Expected Testing ................................................................................................................................... iv

Completing the Self-Assessment Questionnaire .................................................................................. v

Guidance for Non-Applicability of Certain, Specific Requirements .................................................... v

Legal Exception .................................................................................................................................... v

Section 1: Assessment Information ..................................................................................... 1

Section 2: Self-Assessment Questionnaire B ...................................................................... 4

Protect Cardholder Data .......................................................................................................................... 4

Requirement 3: Protect stored cardholder data.................................................................................... 4

Requirement 4: Encrypt transmission of cardholder data across open, public networks ..................... 6

Implement Strong Access Control Measures ........................................................................................ 7

Requirement 7: Restrict access to cardholder data by business need to know ................................... 7

Requirement 9: Restrict physical access to cardholder data ............................................................... 8

Maintain an Information Security Policy .............................................................................................. 12

Requirement 12: Maintain a policy that addresses information security for all personnel ................... 12

Appendix A: Additional PCI DSS Requirements ....................................................................... 15

Appendix A1: Additional PCI DSS Requirements for Shared Hosting Providers ............................ 15

Appendix A2: Additional PCI DSS Requirements for Entities using SSL/early TLS ....................... 15

Appendix A3: Designated Entities Supplemental Validation (DESV) .............................................. 15

Appendix B: Compensating Controls Worksheet ...................................................................... 16

Appendix C: Explanation of Non-Applicability........................................................................... 17

Section 3: Validation and Attestation Details .....................................................................18

PCI DSS v3.2 SAQ B, Rev. 1.1 January 2017

Before You Begin

SAQ B has been developed to address requirements applicable to merchants who process cardholder

data only via imprint machines or standalone, dial-out terminals. SAQ B merchants may be either brick-

and-mortar (card-present) or mail/telephone order (card-not-present) merchants, and do not store

cardholder data on any computer system.

SAQ B merchants confirm that, for this payment channel:

 Your company uses only an imprint machine and/or uses only standalone, dial-out terminals

(connected via a phone line to your processor) to take your customers’ payment card information;

 The standalone, dial-out terminals are not connected to any other systems within your environment;

 The standalone, dial-out terminals are not connected to the Internet;

 Your company does not transmit cardholder data over a network (either an internal network or the

Internet);

 Any cardholder data your company retains is on paper (for example, printed reports or receipts),

and these documents are not received electronically; and

 Your company does not store cardholder data in electronic format.

This SAQ is not applicable to e-commerce channels.

This shortened version of the SAQ includes questions that apply to a specific type of small merchant

environment, as defined in the above eligibility criteria. If there are PCI DSS requirements applicable to

your environment that are not covered in this SAQ, it may be an indication that this SAQ is not suitable for

your environment. Additionally, you must still comply with all applicable PCI DSS requirements in order to

be PCI DSS compliant.

PCI DSS Self-Assessment Completion Steps

1. Identify the applicable SAQ for your environment – refer to the Self-Assessment Questionnaire

Instructions and Guidelines document on PCI SSC website for information.

2. Confirm that your environment is properly scoped and meets the eligibility criteria for the SAQ you

are using (as defined in Part 2g of the Attestation of Compliance).

3. Assess your environment for compliance with applicable PCI DSS requirements.

4. Complete all sections of this document:

 Section 1 (Parts 1 & 2 of the AOC) – Assessment Information and Executive Summary.

 Section 2 – PCI DSS Self-Assessment Questionnaire (SAQ B)

 Section 3 (Parts 3 & 4 of the AOC) – Validation and Attestation Details and Action Plan for

Non-Compliant Requirements (if applicable)

5. Submit the SAQ and Attestation of Compliance (AOC), along with any other requested

documentation—such as ASV scan reports—to your acquirer, payment brand or other requester.

PCI DSS v3.2 SAQ B, Rev. 1.1 January 2017

Understanding the Self-Assessment Questionnaire

The questions contained in the “PCI DSS Question” column in this self-assessment questionnaire are

based on the requirements in the PCI DSS.

Additional resources that provide guidance on PCI DSS requirements and how to complete the self-

assessment questionnaire have been provided to assist with the assessment process. An overview of

some of these resources is provided below:

Document

Includes:

PCI DSS

(PCI Data Security Standard

Requirements and Security

Assessment Procedures)

 Guidance on Scoping

 Guidance on the intent of all PCI DSS Requirements

 Details of testing procedures

 Guidance on Compensating Controls

SAQ Instructions and Guidelines

documents

 Information about all SAQs and their eligibility criteria

 How to determine which SAQ is right for your organization

PCI DSS and PA-DSS Glossary of

Terms, Abbreviations, and Acronyms

 Descriptions and definitions of terms used in the PCI DSS

and self-assessment questionnaires

These and other resources can be found on the PCI SSC website (www.pcisecuritystandards.org).

Organizations are encouraged to review the PCI DSS and other supporting documents before beginning

an assessment.

Expected Testing

The instructions provided in the “Expected Testing” column are based on the testing procedures in the

PCI DSS, and provide a high-level description of the types of testing activities that should be performed in

order to verify that a requirement has been met. Full details of testing procedures for each requirement

can be found in the PCI DSS.

PCI DSS v3.2 SAQ B, Rev. 1.1 January 2017

Completing the Self-Assessment Questionnaire

For each question, there is a choice of responses to indicate your company’s status regarding that

requirement. Only one response should be selected for each question.

A description of the meaning for each response is provided in the table below:

Response

When to use this response:

Yes

The expected testing has been performed, and all elements of the requirement

have been met as stated.

Yes with CCW

(Compensating

Control Worksheet)

The expected testing has been performed, and the requirement has been met

with the assistance of a compensating control.

All responses in this column require completion of a Compensating Control

Worksheet (CCW) in Appendix B of the SAQ.

Information on the use of compensating controls and guidance on how to

complete the worksheet is provided in the PCI DSS.

Some or all elements of the requirement have not been met, or are in the

process of being implemented, or require further testing before it will be known

if they are in place.

N/A

(Not Applicable)

The requirement does not apply to the organization’s environment. (See

Guidance for Non-Applicability of Certain, Specific Requirements below for

examples.)

All responses in this column require a supporting explanation in Appendix C of

the SAQ.

Guidance for Non-Applicability of Certain, Specific Requirements

If any requirements are deemed not applicable to your environment, select the “N/A” option for that

specific requirement, and complete the “Explanation of Non-Applicability” worksheet in Appendix C for

each “N/A” entry.

Legal Exception

If your organization is subject to a legal restriction that prevents the organization from meeting a PCI DSS

requirement, check the “No” column for that requirement and complete the relevant attestation in Part 3.

PCI DSS v3.2 SAQ B, Rev. 1.1 – Section 1: Assessment Information January 2017

Section 1: Assessment Information

Instructions for Submission

This document must be completed as a declaration of the results of the merchant’s self-assessment with the

Payment Card Industry Data Security Standard Requirements and Security Assessment Procedures (PCI

DSS). Complete all sections: The merchant is responsible for ensuring that each section is completed by the

relevant parties, as applicable. Contact acquirer (merchant bank) or the payment brands to determine reporting

and submission procedures.

Part 1. Merchant and Qualified Security Assessor Information

Part 1a. Merchant Organization Information

Company Name:

DBA (doing

business as):

Contact Name:

Title:

Telephone:

E-mail:

Business Address:

City:

State/Province:

Country:

Zip:

URL:

Part 1b. Qualified Security Assessor Company Information (if applicable)

Company Name:

Lead QSA Contact Name:

Title:

Telephone:

E-mail:

Business Address:

City:

State/Province:

Country:

Zip:

URL:

Part 2. Executive Summary

Part 2a. Type of Merchant Business (check all that apply)

Retailer Telecommunication Grocery and Supermarkets

Petroleum E-Commerce Mail order/telephone order (MOTO)

Others (please specify):

What types of payment channels does your

business serve?

Mail order/telephone order (MOTO)

E-Commerce

Card-present (face-to-face)

Which payment channels are covered by this SAQ?

Mail order/telephone order (MOTO)

E-Commerce

Card-present (face-to-face)

Note: If your organization has a payment channel or process that is not covered by this SAQ, consult your

acquirer or payment brand about validation for the other channels.

PCI DSS v3.2 SAQ B, Rev. 1.1 – Section 1: Assessment Information January 2017

Part 2b. Description of Payment Card Business

How and in what capacity does your business

store, process and/or transmit cardholder data?

Part 2c. Locations

List types of facilities and a summary of locations (for example, retail outlets, corporate offices, data centers,

call centers, etc.) included in the PCI DSS review.

Type of facility

Number of facilities

of this type

Location(s) of facility (city, country)

Example: Retail outlets

Boston, MA, USA

Part 2d. Payment Application

Does the organization use one or more Payment Applications? Yes No

Provide the following information regarding the Payment Applications your organization uses:

Payment Application

Name

Version

Number

Application

Vendor

Is application

PA-DSS Listed?

PA-DSS Listing Expiry

date (if applicable)

Yes No

Part 2e. Description of Environment

Provide a high-level description of the environment covered by

this assessment.

For example:

• Connections into and out of the cardholder data environment

(CDE).

• Critical system components within the CDE, such as POS

devices, databases, web servers, etc., and any other

necessary payment components, as applicable.

Does your business use network segmentation to affect the scope of your PCI DSS

environment?

(Refer to “Network Segmentation” section of PCI DSS for guidance on network

segmentation)

Yes No

PCI DSS v3.2 SAQ B, Rev. 1.1 – Section 1: Assessment Information January 2017

Part 2f. Third-Party Service Providers

Does your company use a Qualified Integrator & Reseller (QIR)?

If Yes:

Name of QIR Company:

QIR Individual Name:

Description of services provided by QIR:

Yes No

Does your company share cardholder data with any third-party service providers (for

example, Qualified Integrator & Resellers (QIR), gateways, payment processors, payment

service providers (PSP), web-hosting companies, airline booking agents, loyalty program

agents, etc.)?

Yes No

If Yes:

Name of service provider:

Description of services provided:

Note: Requirement 12.8 applies to all entities in this list.

Part 2g. Eligibility to Complete SAQ B

Merchant certifies eligibility to complete this shortened version of the Self-Assessment Questionnaire

because, for this payment channel:

Merchant uses only an imprint machine to imprint customers’ payment card information and does not

transmit cardholder data over either a phone line or the Internet; and/or

Merchant uses only standalone, dial-out terminals (connected via a phone line to your processor); and

the standalone, dial-out terminals are not connected to the Internet or any other systems within the

merchant environment;

Merchant does not transmit cardholder data over a network (either an internal network or the Internet);

Merchant does not store cardholder data in electronic format; and

If Merchant does store cardholder data, such data is only paper reports or copies of paper receipts

and is not received electronically.

■

PCI DSS v3.2 SAQ B, Rev. 1.1 – Section 2: Self-Assessment Questionnaire January 2017

Section 2: Self-Assessment Questionnaire B

Note: The following questions are numbered according to PCI DSS requirements and testing procedures, as defined in the PCI DSS

Requirements and Security Assessment Procedures document.

Self-assessment completion date:

Protect Cardholder Data

Requirement 3: Protect stored cardholder data

PCI DSS Question

Expected Testing

Response

(Check one response for each

question)

Yes

Yes with

CCW

N/A

3.2

unrecoverable upon completion of the authorization

process?

 Review policies and procedures

 Examine system configurations

 Examine deletion processes

(d) Do all systems adhere to the following requirements

regarding non-storage of sensitive authentication data

after authorization (even if encrypted):

3.2.1

The full contents of any track (from the magnetic stripe

located on the back of a card, equivalent data contained on

a chip, or elsewhere) are not stored after authorization?

This data is alternatively called full track, track, track 1,

track 2, and magnetic-stripe data.

Note: In the normal course of business, the following data

elements from the magnetic stripe may need to be

retained:

 The cardholder’s name,

 Primary account number (PAN),

 Expiration date, and

 Service code

To minimize risk, store only these data elements as needed

for business.

 Examine data sources including:

 Incoming transaction data

 All logs

 History files

 Trace files

 Database schema

 Database contents

PCI DSS v3.2 SAQ B, Rev. 1.1 – Section 2: Self-Assessment Questionnaire January 2017

PCI DSS Question

Expected Testing

Response

(Check one response for each

question)

Yes

Yes with

CCW

N/A

3.2.2

The card verification code or value (three-digit or four-digit

number printed on the front or back of a payment card) is

not stored after authorization?

 Examine data sources including:

 Incoming transaction data

 All logs

 History files

 Trace files

 Database schema

 Database contents

3.2.3

The personal identification number (PIN) or the encrypted

PIN block is not stored after authorization?

 Examine data sources including:

 Incoming transaction data

 All logs

 History files

 Trace files

 Database schema

 Database contents

3.3

Is the PAN masked when displayed (the first six and last

four digits are the maximum number of digits to be

displayed) such that only personnel with a legitimate

business need can see more than the first six/last four

digits of the PAN?

Note: This requirement does not supersede stricter

requirements in place for displays of cardholder data—for

example, legal or payment card brand requirements for

point-of-sale (POS) receipts.

 Review policies and procedures

 Review roles that need access to

displays of full PAN

 Examine system configurations

 Observe displays of PAN

PCI DSS v3.2 SAQ B, Rev. 1.1 – Section 2: Self-Assessment Questionnaire January 2017

Requirement 4: Encrypt transmission of cardholder data across open, public networks

PCI DSS Question

Expected Testing

Response

(Check one response for each

question)

Yes

Yes with

CCW

N/A

4.2

(b) Are policies in place that state that unprotected PANs

are not to be sent via end-user messaging

technologies?

 Review policies and procedures

PCI DSS v3.2 SAQ B, Rev. 1.1 – Section 2: Self-Assessment Questionnaire January 2017

Implement Strong Access Control Measures

Requirement 7: Restrict access to cardholder data by business need to know

PCI DSS Question

Expected Testing

Response

(Check one response for each question)

Yes

Yes with

CCW

N/A

7.1

Is access to system components and cardholder data

limited to only those individuals whose jobs require such

access, as follows:

7.1.2

Is access to privileged user IDs restricted as follows:

 To least privileges necessary to perform job

responsibilities?

 Assigned only to roles that specifically require that

privileged access?

 Examine written access control

policy

 Interview personnel

 Interview management

 Review privileged user IDs

7.1.3

Is access assigned based on individual personnel’s job

classification and function?

 Examine written access control

policy

 Interview management

 Review user IDs

PCI DSS v3.2 SAQ B, Rev. 1.1 – Section 2: Self-Assessment Questionnaire January 2017

Requirement 9: Restrict physical access to cardholder data

PCI DSS Question

Expected Testing

Response

(Check one response for each

question)

Yes

Yes with

CCW

N/A

9.5

Are all media physically secured (including but not limited

to computers, removable electronic media, paper receipts,

paper reports, and faxes)?

For purposes of Requirement 9, “media” refers to all paper

and electronic media containing cardholder data.

 Review policies and procedures

for physically securing media

 Interview personnel

9.6

(a) Is strict control maintained over the internal or external

distribution of any kind of media?

 Review policies and procedures

for distribution of media

(b) Do controls include the following:

9.6.1

Is media classified so the sensitivity of the data can be

determined?

 Review policies and procedures

for media classification

 Interview security personnel

9.6.2

Is media sent by secured courier or other delivery method

that can be accurately tracked?

 Interview personnel

 Examine media distribution

tracking logs and documentation

9.6.3

Is management approval obtained prior to moving the

media (especially when media is distributed to individuals)?

 Interview personnel

 Examine media distribution

tracking logs and documentation

9.7

Is strict control maintained over the storage and

accessibility of media?

 Review policies and procedures

9.8

(a) Is all media destroyed when it is no longer needed for

business or legal reasons?

 Review periodic media destruction

policies and procedures

9.8.1

(a) Are hardcopy materials cross-cut shredded,

incinerated, or pulped so that cardholder data cannot

be reconstructed?

 Review periodic media destruction

policies and procedures

 Interview personnel

 Observe processes

PCI DSS v3.2 SAQ B, Rev. 1.1 – Section 2: Self-Assessment Questionnaire January 2017

PCI DSS Question

Expected Testing

Response

(Check one response for each

question)

Yes

Yes with

CCW

N/A

(b) Are storage containers used for materials that contain

information to be destroyed secured to prevent access

to the contents?

 Review periodic media destruction

policies and procedures

 Examine security of storage

containers

9.9

Are devices that capture payment card data via direct

physical interaction with the card protected against

tampering and substitution as follows?

Note: This requirement applies to card-reading devices

used in card-present transactions (that is, card swipe or

dip) at the point of sale. This requirement is not intended to

apply to manual key-entry components such as computer

keyboards and POS keypads.

(a) Do policies and procedures require that a list of such

devices be maintained?

 Review policies and procedures

(b) Do policies and procedures require that devices are

periodically inspected to look for tampering or

substitution?

 Review policies and procedures

trained to be aware of suspicious behavior and to

report tampering or substitution of devices?

 Review policies and procedures

9.9.1

(a) Does the list of devices include the following?

 Make, model of device

 Location of device (for example, the address of the

site or facility where the device is located)

 Device serial number or other method of unique

identification

 Examine the list of devices

(b) Is the list accurate and up to date?

 Observe devices and device

locations and compare to list

relocated, decommissioned, etc.?

 Interview personnel

PCI DSS v3.2 SAQ B, Rev. 1.1 – Section 2: Self-Assessment Questionnaire January 2017

PCI DSS Question

Expected Testing

Response

(Check one response for each

question)

Yes

Yes with

CCW

N/A

9.9.2

(a) Are device surfaces periodically inspected to detect

tampering (for example, addition of card skimmers to

devices), or substitution (for example, by checking the

serial number or other device characteristics to verify it

has not been swapped with a fraudulent device) as

follows?

Note: Examples of signs that a device might have been

tampered with or substituted include unexpected

attachments or cables plugged into the device, missing or

changed security labels, broken or differently colored

casing, or changes to the serial number or other external

markings.

 Interview personnel

 Observe inspection processes and

compare to defined processes

(b) Are personnel aware of procedures for inspecting

devices?

 Interview personnel

9.9.3

Are personnel trained to be aware of attempted tampering

or replacement of devices, to include the following?

(a) Do training materials for personnel at point-of-sale

locations include the following?

 Verify the identity of any third-party persons

claiming to be repair or maintenance personnel,

prior to granting them access to modify or

troubleshoot devices.

 Do not install, replace, or return devices without

verification.

 Be aware of suspicious behavior around devices

(for example, attempts by unknown persons to

unplug or open devices).

 Report suspicious behavior and indications of

device tampering or substitution to appropriate

personnel (for example, to a manager or security

officer).

 Review training materials

PCI DSS v3.2 SAQ B, Rev. 1.1 – Section 2: Self-Assessment Questionnaire January 2017

PCI DSS Question

Expected Testing

Response

(Check one response for each

question)

Yes

Yes with

CCW

N/A

(b) Have personnel at point-of-sale locations received

training, and are they aware of procedures to detect

and report attempted tampering or replacement of

devices?

 Interview personnel at POS

locations

PCI DSS v3.2 SAQ B, Rev. 1.1 – Section 2: Self-Assessment Questionnaire January 2017

Maintain an Information Security Policy

Requirement 12: Maintain a policy that addresses information security for all personnel

Note: For the purposes of Requirement 12, “personnel” refers to full-time part-time employees, temporary employees and personnel, and

contractors and consultants who are “resident” on the entity’s site or otherwise have access to the company’s site cardholder data environment.

PCI DSS Question

Expected Testing

Response

(Check one response for each

question)

Yes

Yes with

CCW

N/A

12.1

Is a security policy established, published, maintained, and

disseminated to all relevant personnel?

 Review the information security

policy

12.1.1

Is the security policy reviewed at least annually and

updated when the environment changes?

 Review the information security

policy

 Interview responsible personnel

12.3

Are usage policies for critical technologies developed to

define proper use of these technologies and require the

following:

Note: Examples of critical technologies include, but are not

limited to, remote access and wireless technologies,

laptops, tablets, removable electronic media, e-mail usage

and Internet usage.

12.3.1

Explicit approval by authorized parties to use the

technologies?

 Review usage policies

 Interview responsible personnel

12.3.3

A list of all such devices and personnel with access?

 Review usage policies

 Interview responsible personnel

12.3.5

Acceptable uses of the technologies?

 Review usage policies

 Interview responsible personnel

12.4

Do security policy and procedures clearly define

information security responsibilities for all personnel?

 Review information security policy

and procedures

 Interview a sample of responsible

personnel

PCI DSS v3.2 SAQ B, Rev. 1.1 – Section 2: Self-Assessment Questionnaire January 2017

PCI DSS Question

Expected Testing

Response

(Check one response for each

question)

Yes

Yes with

CCW

N/A

12.5

(b) Are the following information security management

responsibilities formally assigned to an individual or

team:

12.5.3

Establishing, documenting, and distributing security

incident response and escalation procedures to ensure

timely and effective handling of all situations?

 Review information security policy

and procedures

12.6

(a) Is a formal security awareness program in place to

make all personnel aware of the cardholder data

security policy and procedures?

 Review security awareness

program

12.8

Are policies and procedures maintained and implemented

to manage service providers with whom cardholder data is

shared, or that could affect the security of cardholder data,

as follows:

12.8.1

Is a list of service providers maintained, including a

description of the service(s) provided?

 Review policies and procedures

 Observe processes

 Review list of service providers

12.8.2

Is a written agreement maintained that includes an

acknowledgement that the service providers are

responsible for the security of cardholder data the service

providers possess or otherwise store, process, or transmit

on behalf of the customer, or to the extent that they could

impact the security of the customer’s cardholder data

environment?

Note: The exact wording of an acknowledgement will

depend on the agreement between the two parties, the

details of the service being provided, and the

responsibilities assigned to each party. The

acknowledgement does not have to include the exact

wording provided in this requirement.

 Observe written agreements

 Review policies and procedures

12.8.3

Is there an established process for engaging service

providers, including proper due diligence prior to

engagement?

 Observe processes

 Review policies and procedures

and supporting documentation

PCI DSS v3.2 SAQ B, Rev. 1.1 – Section 2: Self-Assessment Questionnaire January 2017

PCI DSS Question

Expected Testing

Response

(Check one response for each

question)

Yes

Yes with

CCW

N/A

12.8.4

Is a program maintained to monitor service providers’ PCI

DSS compliance status at least annually?

 Observe processes

 Review policies and procedures

and supporting documentation

12.8.5

Is information maintained about which PCI DSS

requirements are managed by each service provider, and

which are managed by the entity?

 Observe processes

 Review policies and procedures

and supporting documentation

12.10.1

(a) Has an incident response plan been created to be

implemented in the event of system breach?

 Review the incident response plan

 Review incident response plan

procedures

PCI DSS v3.2 SAQ B, Rev. 1.1 – Section 2: Self-Assessment Questionnaire January 2017

Appendix A: Additional PCI DSS Requirements

Appendix A1: Additional PCI DSS Requirements for Shared Hosting Providers

This appendix is not used for merchant assessments.

Appendix A2: Additional PCI DSS Requirements for Entities using SSL/early TLS

This appendix is not used for SAQ B merchant assessments

Appendix A3: Designated Entities Supplemental Validation (DESV)

This Appendix applies only to entities designated by a payment brand(s) or acquirer as requiring

additional validation of existing PCI DSS requirements. Entities required to validate to this Appendix

should use the DESV Supplemental Reporting Template and Supplemental Attestation of Compliance

for reporting, and consult with the applicable payment brand and/or acquirer for submission procedures.

PCI DSS v3.2 SAQ B, Rev. 1.1 – Section 2: Self-Assessment Questionnaire January 2017

Appendix B: Compensating Controls Worksheet

Use this worksheet to define compensating controls for any requirement where “YES with CCW” was

checked.

Note: Only companies that have undertaken a risk analysis and have legitimate technological or

documented business constraints can consider the use of compensating controls to achieve compliance.

Refer to Appendices B, C, and D of PCI DSS for information about compensating controls and guidance

on how to complete this worksheet.

Requirement Number and Definition:

Information Required

Explanation

1. Constraints

List constraints precluding compliance

with the original requirement.

2. Objective

Define the objective of the original

control; identify the objective met by

the compensating control.

3. Identified Risk

Identify any additional risk posed by the

lack of the original control.

4. Definition of

Compensating

Controls

Define the compensating controls and

explain how they address the

objectives of the original control and

the increased risk, if any.

5. Validation of

Compensating

Controls

Define how the compensating controls

were validated and tested.

6. Maintenance

Define process and controls in place to

maintain compensating controls.

PCI DSS v3.2 SAQ B, Rev. 1.1 – Section 2: Self-Assessment Questionnaire January 2017

Appendix C: Explanation of Non-Applicability

If the “N/A” (Not Applicable) column was checked in the questionnaire, use this worksheet to explain why

the related requirement is not applicable to your organization.

Requirement

Reason Requirement is Not Applicable

Example:

3.4

Cardholder data is never stored electronically

PCI DSS v3.2 SAQ B, Rev. 1.1 – Section 3: Validation and Attestation Details January 2017

Section 3: Validation and Attestation Details

Part 3. PCI DSS Validation

This AOC is based on results noted in SAQ B (Section 2), dated (SAQ completion date).

Based on the results documented in the SAQ B noted above, the signatories identified in Parts 3b-3d, as

applicable, assert(s) the following compliance status for the entity identified in Part 2 of this document:

(check one):

Compliant: All sections of the PCI DSS SAQ are complete, all questions answered affirmatively,

resulting in an overall COMPLIANT rating; thereby (Merchant Company Name) has demonstrated full

compliance with the PCI DSS.

Non-Compliant: Not all sections of the PCI DSS SAQ are complete, or not all questions are answered

affirmatively, resulting in an overall NON-COMPLIANT rating, thereby (Merchant Company Name) has

not demonstrated full compliance with the PCI DSS.

Target Date for Compliance:

An entity submitting this form with a status of Non-Compliant may be required to complete the Action

Plan in Part 4 of this document. Check with your acquirer or the payment brand(s) before completing

Part 4.

Compliant but with Legal exception: One or more requirements are marked “No” due to a legal

restriction that prevents the requirement from being met. This option requires additional review from

acquirer or payment brand.

If checked, complete the following:

Affected Requirement

Details of how legal constraint prevents requirement being met

Part 3a. Acknowledgement of Status

Signatory(s) confirms:

(Check all that apply)

PCI DSS Self-Assessment Questionnaire B, Version (version of SAQ), was completed according to the

instructions therein.

All information within the above-referenced SAQ and in this attestation fairly represents the results of

my assessment in all material respects.

I have confirmed with my payment application vendor that my payment system does not store sensitive

authentication data after authorization.

I have read the PCI DSS and I recognize that I must maintain PCI DSS compliance, as applicable to

my environment, at all times.

If my environment changes, I recognize I must reassess my environment and implement any additional

PCI DSS requirements that apply.

PCI DSS v3.2 SAQ B, Rev. 1.1 – Section 3: Validation and Attestation Details January 2017

Part 3a. Acknowledgement of Status (continued)

No evidence of full track data

, CAV2, CVC2, CID, or CVV2 data

, or PIN data

storage after

transaction authorization was found on ANY system reviewed during this assessment.

ASV scans are being completed by the PCI SSC Approved Scanning Vendor (ASV Name)

Part 3b. Merchant Attestation

Signature of Merchant Executive Officer



Date:

Merchant Executive Officer Name:

Title:

Part 3c. Qualified Security Assessor (QSA) Acknowledgement (if applicable)

If a QSA was involved or assisted with this

assessment, describe the role performed:

Signature of Duly Authorized Officer of QSA Company 

Date:

Duly Authorized Officer Name:

QSA Company:

Part 3d. Internal Security Assessor (ISA) Involvement (if applicable)

If an ISA(s) was involved or assisted with this

assessment, identify the ISA personnel and

describe the role performed:

Data encoded in the magnetic stripe or equivalent data on a chip used for authorization during a card-present transaction. Entities

may not retain full track data after transaction authorization. The only elements of track data that may be retained are primary

account number (PAN), expiration date, and cardholder name.

The three- or four-digit value printed by the signature panel or on the face of a payment card used to verify card-not-present

transactions.

Personal identification number entered by cardholder during a card-present transaction, and/or encrypted PIN block present

within the transaction message.

PCI DSS v3.2 SAQ B, Rev. 1.1 – Section 3: Validation and Attestation Details January 2017

Part 4. Action Plan for Non-Compliant Requirements

Select the appropriate response for “Compliant to PCI DSS Requirements” for each requirement. If you

answer “No” to any of the requirements, you may be required to provide the date your Company expects to be

compliant with the requirement and a brief description of the actions being taken to meet the requirement.

Check with your acquirer or the payment brand(s) before completing Part 4.

PCI DSS

Requirement*

Description of Requirement

Compliant to PCI

DSS Requirements

(Select One)

Remediation Date and Actions

(If “NO” selected for any

Requirement)

YES

Protect stored cardholder data

Encrypt transmission of

cardholder data across open,

public networks

Restrict access to cardholder

data by business need to know

Restrict physical access to

cardholder data

Maintain a policy that addresses

information security for all

personnel

* PCI DSS Requirements indicated here refer to the questions in Section 2 of the SAQ.

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